New Club Registration

Please complete the following information and submit with payment. This form is ONLY for NEW CLUBS. The new club registration fee is $100 per person for the period of Oct 1, 2022 – Sept 30, 2023. Indicate below the number of people you would like to register. (The system will automatically calculate the dollar amount.) Thank you!

DO NOT SUBMIT IF YOU ARE JOINING AN EXISTING CLUB. PLEASE REACH OUT TO YOUR CLUB SECRETARY. THIS FORM IS ONLY FOR BRAND NEW CLUBS.

"*" indicates required fields

NAME*

First Last

ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PHONE

CLUB NAME

CLUB LOCATION

MEMBERSHIP TYPE

If you are a transfer Kiwanian or a service leadership program alumni, please email [email protected] instead of completing this form. This form is for NEW Kiwanians and Corporate Members for a NEW CLUB.

SUBMITTED BY (if other than member listed above)

New Club Membership(s). Please indicate number of people:

Price: $100.00

Total

Credit Card

Card Details

Cardholder Name

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Kids Need Kiwanis

New Club Registration

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